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House Bill Would Blow Hole in CDC Budget

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The House Energy and Commerce Committee begins considering spending-cut legislation today that would, among other things, abolish health reform’s Prevention and Public Health (PPH) Fund. Critics claim the fund is a “slush fund” giving the Secretary of Health and Human Services (HHS) “unaccountable access to billions of taxpayer dollars for pet projects.” That assertion is baseless.

Since 2014, Congress has exercised detailed control over the fund, which supports programs to advance disease prevention and public health, through the annual appropriations process. Eliminating the fund would open a large budget hole for the Centers for Disease Control and Prevention (CDC), which gets 95 percent of the fund’s resources. The hole would be very hard to fill, as annual spending caps and additional sequestration cuts severely constrain funding for appropriated programs.

Health reform, which established and permanently funded the PPH Fund, invited Congress to specify uses for it each year in appropriations bills, leaving those decisions to the HHS Secretary only if lawmakers chose not to. Congress initially didn’t exercise its authority, but since 2014 it has consistently done so. The 2014, 2015, and 2016 Labor-HHS-Education appropriations bills all specify the programs and activities for the fund and the precise amounts for each.

In fact, the executive branch has less discretion over the PPH Fund than over regular appropriations, as the 2014-2016 appropriations bills prohibit HHS from transferring any PPH funds. They also impose special transparency requirements, directing HHS to maintain this website with detailed information about the fund’s uses.

In 2016, Congress directed $892 million from the PPH Fund to CDC and the remaining $40 million to other HHS agencies. The fund supports one-eighth of CDC’s appropriated budget. This year, for example, the fund provides (among other things):

half of the funding for the CDC’s immunization programs;

all of the funding for a block grant to help states detect and respond to infectious diseases and other public health threats;

two-fifths of the funding for CDC efforts to prevent heart disease, stroke, and diabetes;

three-fifths of the funding for CDC programs to reduce tobacco use; and

all of the funding for CDC activities to prevent lead poisoning. (Recent events in Flint, Michigan underscore the importance of preventing lead poisoning.)

If Congress abolished the fund, appropriators would probably try to reallocate money from elsewhere in the Labor-HHS-Education appropriations bill to make up part of the shortfall at CDC and other HHS agencies. But they’d have only a limited ability to do so. The caps, even with the sequestration relief provided in last fall’s bipartisan budget deal, allow no increase at all in overall non-defense appropriations in 2017 and call for a small cut in 2018. So any increases for CDC and other agencies to offset the loss of the PPH Fund would simply open up holes in other parts of the budget.